Clinic Development Update and Plan Clinic Roster/ Services and Evaluations Georgian NPLC Board Report from the Nurse Practitioner Lead Date: January 19, 2015 Item Task Timeline Done Our Clients In Q3 we implemented strategies to increase awareness of the Nurse Practitioner role as well as the services offered at the Clinic. The expanded services to the Georgian College students was executed resulting in 662 appointments in Q3: 270 Nurse Practitioner student appointments 376 Registered Nurse student appointments 16 Registered Dietitian and Social Work The Clinic has been staffed with 3 FTE NP s since November 2014. The team has adjusted accordingly with the reduction in the NP FTE. We are no longer actively seeking patients, but are still accepting anyone who applies. As of December 31, 2015 our patient enrollment is 2882. NP-PHC Program Services Full Scope Primary Care In Q3 the NP s had 820 patient encounters Services provided Prevention 143, Acute 604, Screening 408, Supportive 1121, Chronic 175 Focus was on Advanced Access and creating same day booking so that patients will be able to see a practitioner when they want or need to. Currently third next available stands at 2.0 days. Potential Research Project Research study is through the University of Toronto with Faith Donald Primary Care research project entitled Measuring factors that influence nurse practitioner (NP) activities and the implications for optimizing NP patient panel size in primary healthcare settings, funded by the Ontario Ministry of Health and Long Term Care Clearance from the Ethics Review Board required (anticipated by February/March 2015) RN Program Services Flu Clinics were run in late October with 114 people receiving the flu shot. Working on gathering information of people who received flu shots elsewhere The RN s provided immunization services to the GC student population starting in September. This also included completing and signing off on paperwork for
student placements. Social Work Program Services: Individual Counselling: 110 appointments in Q3 (excludes no shows. There we 25 no shows in Q3). Group Counselling : Mental Health and Wellness Week In partnership with Georgian College, November 17-22 nd. Involved in organizing committee as well as sub-committee for workshops. Liaison for organized workshops by Hospice with the event focusing on the bucket list and caregiver wellness. Prepared and delivered a workshop on Sleep Hygiene Chronic Disease Self-Management Program September 16-October 21, 2014. Clinical Team Support Liaise with Hospice Simcoe, CAS, MVP and CMHA at the NP s request. Met with the MVP social worker to learn more about their program and to consult on community resources. Future Plan: Program development for Chronic Pain group in collaboration with physiotherapy Anxiety workshop Tour and information session of new Busby Centre location Registered Dietitian Program Services: Food and Mood: the workshop ran for 2 evenings in November and December. It is a workshop developed for participants to better understand the chemical and physical reactions that occur based on our moods. Workshop also teaches participants strategies to overcome their emotional eating and become more mindful. The workshop engages you in multiple ways using PowerPoint, games, food demonstrations and brainstorming. Chronic Disease Self- Management: A 6 week workshop (2.5 hours per week September -October) that was designed by the Stanford University School of Medicine and is designed to help participants lean the information and skills they need to manage their chronic conditions on a daily basis while doing the things they need and want to do. The workshop provides clients with tips and strategies to help participants build confidence in managing their chronic illness so that they may live a productive, health life. The workshop is led by trained peer facilitators. This program will be running again in March 2015. Grocery Store Tour: Clients of the clinic are guided
through the Grocery Store by the Registered Dietitian to get a hands on look at how to make healthier choices when shopping. During the tour clients will be shown how to properly read food labels; shown which is the healthiest choice between similar products, given different meal ideas and how to increase variety in their daily menu. Georgian Food Locker: GNPLC Dietitian has partnered with the Georgian Food Locker, an anonymous food bank for students, to provide them with resources and advice on how to best use the food donated to the food bank. Students who access the food locker are also given the dietitians contact information to book an appointment to discuss budgeting and cooking ideas. Georgian Residences: GNPLC dietitian has partnered with the Georgian residence coordinators to support students in residence with learning opportunities and presentations. Southlake Regional Eating Disorders Program: In the Fall began working in collaboration with Southlake Regional Eating Disorders team to support clients who are attending Georgian College and trying to overcome their eating disorder. Future Plan: Diabetes Clinic and walking program for registered patients. OTN Ontario Telehealth Network : Q3 stats include 76 clinical events. The LHIN is looking for 225 clinical visits per fiscal. YTD we are standing at 162. In Q3we covered for FHT OTN coordinator for 3 weeks and provided appointments to clients in her absence. Quality Improvement Plan Third Next available appointment measured in December and it was 2.0 days. Third next available appointment will be measured in February 2015. 2015-2016 QI plan will be submitted for approval at the March 2015 Board of Directors meeting. Recall letters for cancer screening were sent out in October 2014 and we will continue to send out letters to patients to inform them that they are due for screening on a quarterly basis. Will continue to work towards data integrity. Progress has been made with RN s helping out with populating the bands in the EMR. Staffing We now have: 3 NP s 1.5 RN s 1 RD Our People
1 SW 0.7 OTN RN 4 Admin Open Positions Employee Postings: Clinic Director/Nurse Practitioner Lead position open. Benjamin Wiebe and Kevin Linnen filling the position as interim co-leads. 0.5 FTE Pharmacist Board Postings: Currently, recruiting for one (1) Nurse Practitioner. Clinic Team Development Community Partnerships LHIN Georgian College Media Education Sessions attended by the clinical team in Q3 included: Hospice Simcoe Let s Talk Advance Care Planning Don t Just Do Something Stand There Polypharmacy in the Elderly Hypertension in the Elderly Our Care and Community Partners In December we received word from the MOHLTC that our proposal in partnership with the BCFHT, CHC, Huronia NPLC had been successful. Preliminary meeting with the CHC was held in December to discuss needs, program ideas, space etc. Contacts have been identified in Innisfil and Angus and initial contact has been made for the potential GNPLC expansion/satellite. Nothing to report at this time Mental Health & Wellness Week committee preparation for November 17, 2014 launch. RD and SW participating in planning committee Meeting with Cassandra Thompson and Nina Koniuch to discuss the possibility of a partnership for space regarding physiotherapy. Our Internal Systems and Processes Website: Looking into SEO for the website to better our results on search engines such as Google, Yahoo etc. Prepared video with GC marketing for webpage receiving final copy January 13, 2015. It will be posted on both the GNPLC website as well as the Nurse Practitioner page on the Georgian College website. EMR: Technology Governance Lease RFP Implemented new transcription services for NP and MD through Accuro. Looking at the possibility of implementing automated appointment reminders to reduce no show/down time. Nothing to report at this time Our Financial Commitments No update or issues at this time No RFP s at this time.
MOHLTC Our External Commitments Primary Care branch has provided a template to allow for quarterly in-year reallocation requests. The document is to be used to formally request onetime funding for operational needs, using available surplus funds from the current fiscal year within the existing budgets. Feedback on Patient Enrollment Entity vs Individual (NPLC teleconference) Situation: All Ontario residents should be linked with a primary care provider. How can we best identify this linkage so that we can allocate services equitably? Enrolling to the entity (NPLC) vs Enrolling to the Individual Practitioner. Based on the Auditor General s Report there is a desire to clearly identify who the primary care provider is for each Ontarian. Discussions happening with NPAO, AOHC, AFHTO, NPLC s and MOHLTC on how to accomplish this. Currently, NPLC s do not enrol their clients. NPLC s are registering a client which is more of an internal administrative process. Registration does not formally connect the patients OHIP number to the practitioner or the entity in the eyes of the MOHLTC. Therefore, a patient could be registered to an NPLC but enrolled to a FHT at the same time. Goals of the MOHLTC Ensure that every Ontarian has access to a primary care provider Primary Care Guarantee an announcement by Kathleen Wynne which states that every patient should have access to an MD or NP by 2018 Enhance information sharing including health data at the aggregate level as well as personal health information. PHI would be used to ensure screening and evidence based care. Easier tracking through the health care system Increase accountability by ensuring the primary care provider is more available and decrease outside use such as walk in clinics Identify where the double-dipping is occurring Develop funding mechanisms based on rosters of patients and community populations rather than by service provision Potential benefits of enrolling within NPLCs NPLC would be able to determine with more accuracy the population of patients it serves. Allow for easier transmission of reports throughout the system (i.e. Cancer Care Ontario, reports from specialists, hospital reports etc.) If patients were enrolled with the NPLC they would then be removed from the Health Care Connect list of unattached patients. This is currently not happening. Potential risks of enrolling within NPLC s Time and resources to educate client and obtain informed consent If client is enrolled with an MD they may decline to sign an enrolment form Process could disrupt team dynamics NP s taking roster of patients with him/her if they were to leave
Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Notes MOHLTC has indicated that it would take 4 to 5 years to change its internal processes and infrastructure to enroll to the entity (the clinic). Enrolling to the individual NP could happen in a fairly short span of time (within 6-12 months) Summary of Patient Numbers Enrollment: as of December 31, 2014: 2882 160 140 120 100 80 Actual Enrollment Month End Waitlist 60 40 20 0
Patients Patient Encounters Reasons for Patient Visit 2000 1800 1600 1400 1200 1000 800 600 400 200 1st Quarter patient encounters 1442 2nd quarter patient encounters 1340 3rd quarter patient encounters 820 0 Preventio n Screening Acute Rehab/Chr onic Supportiv e 173 660 1221 435 1875 70 539 927 361 1623 143 408 604 175 1121 Prevention includes immunizations Screening- includes, prenatal, antenatal, breast cancer, colorectal cancer, diabetes, heart disease, infectious diseases, mental health screen, osteoporosis, cervical cancer, well baby Rehabilitative includes treatment of chronic disease, injury, ongoing disability Supportive includes education, advocacy, and coordinate with community services, counselling, and palliative care. Patient Impact/Personal Stories Excerpt from card received from patient Thank you for all of your dedication and support to me through all the years. I truly believe that I am only ok medically because of the care that you give me. Your dedication to get me to the people I need is above standard!! I will forever be grateful for all that you do. I am lucky to have found a human medical professional who still has a great heart.